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Mary L. Lussier MD EMG Nerve Conduction Studies 588 Pawtucket Ave. Pawtucket RI 02860 Phone 401-722-2400 Fax 401-728-3920 NEURO PATIENT INTAKE FORM Patient s Name DOB// INSTRUCTIONS Your test may take up to 2 hours. YES NO Have you had Spine Surgery on your Neck Are you currently taking Blood-Thinning Medications e.g. dabigatran edoxaban Lixiana Do you have Diabetes Are you Dependent Have you been diagnosed with Peripheral Neuropathy Is a Pacemaker Defibrillator/Cardioverter or Deep Brain...
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Lussier MD is a medical document containing information about a patient's medical history.
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